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Palonosetron and dexamethasone for the prevention of nausea and vomiting in patients receiving allogeneic hematopoietic stem cell transplantation

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Abstract

Purpose

The primary aim of this study was to evaluate the efficacy of palonosetron combined with dexamethasone in the prevention of vomiting, and especially nausea, in patients receiving allogeneic stem cell transplantation.

Methods

Palonosetron 0.25 mg was given to 27 patients receiving allogeneic transplantation on the first day of conditioning, and then every other day during the entire conditioning period. Dexamethasone was given daily also during conditioning. Vomiting and nausea were recorded daily according to CTCAE version 4.0 from the start of conditioning to Day 7 after transplantation. In addition, MASCC antiemetic tool (MAT) was also used in parallel to evaluate the intensity of nausea.

Results

The treatment was well tolerated; 25.9 and 40.7 % of the patients had grade 2/3 vomiting and nausea respectively during conditioning. The incidences of grade 2/3 vomiting and nausea were even higher in the first week after transplantation (40.7 and 51.8 %, respectively). The score of MAT correlated well with the grade of CTCAE. However, the difference in the mean intensity of nausea between period of conditioning and the first week after HSCT was significant only by using MAT (0.96 ± 1.829 vs. 3.81 ± 3.386, p = 0.001) but not CTCAE (1.26 ± 0.903 vs. 1.63 ± 0.967, p = 0.152).

Conclusion

Palonosetron combined with dexamethasone is effective in preventing vomiting during conditioning. However, more effort should be made to alleviate nausea during conditioning and both nausea and vomiting in the first week after transplantation. Furthermore, MAT has a higher discriminant power than CTCAE in assessing the intensity of nausea in patients receiving allogeneic transplantation.

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Acknowledgments

The authors would like to thank all the nursing staff of BMT unit (5H ward) and Yu-Ting Ho (research coordinator of this study) for their great help in this study. This study was supported in part by the research grant from Department of Health of Taiwan (DOH102-TD-C-111-005) and China Medical University Hospital (DMR 98-008).

Authorship and disclosures

SP Yeh, WC Lo, CY Hsieh designed the study, LY Bai, CC Lin, PH Lin, CY Lin, YM Liao contributed to clinical data collection, CF Chiu supervised the process of this study and reviewed the manuscript. All the authors have no relationships or conflict of interest to declare.

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Authors and Affiliations

  1. Division of Hematology and Oncology, Department of Internal Medicine, China Medical University Hospital, 2 Yuh Der Road, Taichung 404, Taiwan

    Su-Peng Yeh, Woei-Chung Lo, Ching-Yun Hsieh, Li-Yuan Bai, Ching-Chan Lin, Po-Han Lin, Chen-Yuan Lin, Yu-Min Liao & Chang-Fang Chiu

  2. Stem Cell Research Laboratory, Department of Medical Research, China Medical University Hospital, 2 Yuh Der Road, Taichung 404, Taiwan

    Su-Peng Yeh

  3. China Medical University, 2 Yuh Der Road, Taichung 404, Taiwan

    Su-Peng Yeh, Li-Yuan Bai & Chang-Fang Chiu

  4. Regency Specialist Hospital, No.1 Jalan Suria, Bandar Seri Alam, 81750, Masai, Johor, Malaysia

    Woei-Chung Lo

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  1. Su-Peng Yeh
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Correspondence to Su-Peng Yeh.

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Supplementary Figure 1

Incidence of any vomiting during conditioning and the first week after HSCT. The use of first-generation 5-HT3 RA is associated with significant higher incidence of any vomiting (grades 1–3) both during conditioning (91.7 vs. 63.0 %, p = 0.017) and the first week after transplantation (91.7 vs. 66.7 %, p = 0.032) (JPEG 57 kb)

Supplementary Table 1

Comparison of patients using palonosetron or first-generation 5-HT RA during conditioning therapy (DOCX 15 kb)

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Yeh, SP., Lo, WC., Hsieh, CY. et al. Palonosetron and dexamethasone for the prevention of nausea and vomiting in patients receiving allogeneic hematopoietic stem cell transplantation. Support Care Cancer 22, 1199–1206 (2014). https://doi.org/10.1007/s00520-013-2072-4

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  • DOI: https://doi.org/10.1007/s00520-013-2072-4

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